Prevenar 20 Vaccine: Who Should Get the Pneumonia Vaccine and How Many Doses?

Prevenar 20 is a conjugate vaccine developed to build immunity against 20 different types of the pneumococcus bacterium. Although it is commonly known as the “pneumonia vaccine”, the serious infections pneumococci can cause are not limited to the lungs. In this article I explain the scope of the vaccine, who should be assessed for it, and how previous vaccines affect the vaccination plan.

The answer to “I get a flu jab every year; do I also need a pneumonia vaccine?” depends on the person’s age and health status. Flu and pneumococcal vaccines target different germs. Having one does not remove the need for the other.

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What is pneumococcus and what diseases does it cause?

Pneumococcus, scientifically known as Streptococcus pneumoniae, is a bacterium that can cause infection in different organs. Apart from pneumonia, it can also cause diseases such as meningitis, bloodstream infection and middle ear infection.

The bacterium can spread through close contact via respiratory secretions. The course of infection varies with age, the immune system and coexisting conditions. Severe illness requiring hospital treatment can develop, especially in people in risk groups.

Pneumococcal infections can be treated with antibiotics; however, antibiotic resistance in some bacteria can make treatment more difficult. For this reason, prevention before the illness develops is important in suitable individuals. ^[1]

What is the Prevenar 20 vaccine?

The number in the name Prevenar 20 refers to the 20 different pneumococcal serotypes the vaccine targets. A serotype describes subtypes of the same bacterium with different capsule characteristics.

The vaccine does not contain live bacteria. It is made with “conjugate” technology, in which sugar structures from the bacterial capsule are attached to a carrier protein. This structure helps the immune system recognise the targets.

The broad coverage of the vaccine is valuable; however, it does not mean that it “prevents all pneumonia”. Pneumonia can also be caused by other bacteria and viruses. ^[2]

Who is Prevenar 20 recommended for?

Older age is an important factor when assessing the need for a pneumococcal vaccine. In addition, some health conditions can increase the risk at younger ages too.

Situations in which the need for vaccination should be specifically assessed include:

• Chronic heart or lung disease
• Diabetes
• Chronic kidney or liver disease
• Diseases and treatments that suppress the immune system
• Removal or poor function of the spleen
• Cerebrospinal fluid leak or a cochlear implant
• Smoking

This list does not mean the same dosing schedule applies to everyone. The choice and timing of the vaccine are assessed together with previous doses. ^[3]

Is the pneumonia vaccine only given after age 65?

No. Associating the pneumococcal vaccine only with people over 65 may cause younger risk groups to be overlooked.

Current CDC recommendations also include adults aged 50 and over who have never received a conjugate pneumococcal vaccine or whose history is unknown. It should be remembered that this is a US recommendation. In Turkey, the decision should be made in line with local guidelines and the current licensing information for the product used. ^[4]

How many doses of Prevenar 20 are given?

In adults, Prevenar 20 is usually given as a single intramuscular dose. In children, the number of doses depends on age and previous pneumococcal vaccines.

In the European product information, the routine series started in early infancy consists of four doses. Catch-up vaccination in older children may be planned differently. For this reason, the “single dose” information for adults should not be generalised to all age groups. ^[5]

Can people who have had a pneumonia vaccine before receive Prevenar 20?

In some people, Prevenar 20 may be considered after previous pneumococcal vaccines. However, the decision requires knowing the name of the earlier vaccine and the date it was given.

“I had a pneumonia vaccine a few years ago” is not enough information on its own. Prevenar 13, other conjugate vaccines and PPSV23 are different vaccines; the need for a further dose and the waiting interval may not be the same.

After PCV20, a separate PPSV23 dose is generally not needed in standard adult schedules. In special situations such as stem cell transplantation, different protocols may apply. ^[4]

How is the protection of Prevenar 20 assessed?

Prevenar 20 studies assessed the immune response the vaccine produces against the serotypes it targets. These data form the basis of the vaccine’s licensing.

However, it would not be accurate to give a single “percentage protection against pneumonia” that applies to everyone. Protection can vary depending on the serotype causing the disease and the individual’s characteristics. The right expectation is that the vaccine reduces the risk of disease caused by the pneumococcal types it covers. ^[2]

What are the side effects of the Prevenar 20 vaccine?

The most commonly reported side effects are pain at the injection site, muscle pain, tiredness and headache. In children, irritability, decreased appetite and changes in sleep pattern may also occur.

If a serious allergic reaction occurred after a previous vaccine dose, this must be shared before vaccination. Having no side effects does not mean the vaccine is ineffective, and having marked side effects does not mean it provides more protection. ^[5]

Frequently asked questions about Prevenar 20